What are nursing interventions for autism?

Answer 1

Nursing interventionsThe Individuals with Disabilities Education Act mandates that all disabled children, including those with severe autism, receive an education through age 21. Thus, many children with ASD receive nursing care in school settings. Such care requires up-to-the-moment knowledge of the disorder, patience, and much creativity. Even seemingly simple tasks, such as assistance with feeding and dressing, toileting, and first aid, can pose a challenge, because new environments and changes in routine cause these children stress or even terror. A visit to a healthcare office may induce severe tantrums, self-abuse (such as attempted head-banging or self-biting), and physical aggression. In many cases, those who know a child well can predict a severe tantrum from subtle warning signs, but a relative stranger (such as a nurse) may have no warning of a behavioral eruption.

To prevent such situations, many experts recommend that children with autism undergo desensitization by visiting the healthcare office regularly and getting familiar with the environment and staff. No procedures should be attempted during this "get-acquainted" period. Instead, the child should be led step by step through a process such as the following: For several visits, the child enters the office, sits in a particular area, waits to be called, greets the nurse, and leaves without having an invasive procedure. At the next visit, the child may be shown a thermometer and asked to show the nurse his or her hand and open the mouth. With subsequent visits over time, the potential for a tantrum or other behavioral eruption decreases. "Are we communicating?"Poor communication is a chief limitation for children with ASD, as many have a severe language impairment. Your efforts at communicating are most likely to succeed if you speak clearly, using short sentences and crystal-clear phrases. Be as concrete as possible. Ask specific questions, such as, "Does your tummy hurt?" or "Does your head hurt?" instead of the vague "What hurts you?"

Use repetition and keep your tone of voice pleasant and cheerful. If verbal intervention is ineffective, be aware that some autistic children may response to visual cues. Nothing is routineNursing procedures considered typical in most school settings may be challenging for children with ASD. For those who are hypersensitive to touch, health screenings may be difficult; what other students experience as an empathic hand on the shoulder might feel painful to one with autism. So before initiating any assessment or procedure, be sure to establish eye contact. Know that calling the child's name may have no effect, so you may need to gently turn the child's head toward you.

Research consistently shows that praise is an effective reinforcer. When the child complies with a request, offer a warm compliment that specifically identifies the behavior you wish to reinforce, such as, "What a good job you're doing with turning toward me!" or "Thank you for looking at my face."

Don't be surprised if you need several sessions to complete a simple screening process with an autistic child. During interactions that require routine nursing care, such as taking a temperature or auscultating the lungs, you may find distraction an effective tool.

Alerting parents to upcoming health screenings is useful in the preparation process. Some children with autism are extremely sensitive to changes in routine; therefore, parents may prefer that screening be done at the child's usual place of medical care. Administering drugsIf the child takes medications, try to administer them using exactly the same procedure and words each time. To teach the child to accept and swallow the medication, first write out all the steps involved: Sit down appropriately, open the mouth wide, and so on. Choose a motivator that's personally relevant to the child (say, a piece of apple) and reward each cooperative step.

Whether performing a screening or a procedure such as medication administration, always maintain a safe environment. Before the appointment, remove from the exam area any object the child could use for self-injury or aggression. Be aware that increased risk for such injury is related to the tendency of many children with ASD to exhibit impulsive and disorganized motor activity, self-stimulatory behaviors, pica, possible seizure activity, and altered sensitivity to pain. Keep in mind the risk of injury from self-abuse or a severe tantrum. Value vigilanceChildren with ASD require significant nursing awareness on an ongoing basis. Some have chronic somatosensory disturbances that may involve extreme sensitivity to sounds, odors, touch, and textures. Others have sensory underreactivity, including imperviousness to pain. During drug administration or events such as nosebleed or physical injury, such over- or underreactivity can be challenging for caregivers.

For example, an autistic child may become extremely agitated if you attempt to apply an adhesive bandage; as an alternative, use spray-on or liquid bandaging to cover an open wound and prevent the spread of body fluids. Another child might fly into a hysterical tantrum if an ice pack is applied, precluding the usual first-aid treatments. Consult with the parent when choosing appropriate care measures.

Stay alert for self-injurious behaviors, such as head-banging, hair pulling, and biting or scratching oneself (which may present as scars or open wounds on the hands or wrists). Some children repeatedly pick at sores until they bleed. Typically, these behaviors occur when the child is frustrated, fatigued, or overstimulated, and may come to the school nurse's attention if they require treatment. Maintain good communication with teachers and parents when caring for such injuries.